Infection Trends in US Nursing Homes, 2006–2013

Published in: Journal of the American Medical Directors AssociationVolume 18, Issue 7 (July 2017), Pages 635.e9-635.e20. doi: 10.1016/j.jamda.2017.04.003

Posted on RAND.org on July 13, 2017

by Carolyn T. A. Herzig, Andrew W. Dick, Mark J. Sorbero, Monika Pogorzelska-Maziarz, Catherine C. Cohen, Elaine L. Larson, Patricia Stone

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The objectives of this study were to estimate trends in the prevalence of infections in nursing home (NH) residents using 2006–2013 Minimum Data Set (MDS) data, estimate the number of all infections in 2013, and evaluate differences in trends between MDS versions 2.0 and 3.0. Retrospective study. NHs in the United States. All NH residents with a quarterly or annual MDS assessment in 2006–2013 (n = 30,366,807 assessments). MDS 2.0 and 3.0 quarterly and annual assessment data (2006–2013) from over 15,000 NHs were used to estimate the 7-day prevalence of multidrug-resistant organism (MDRO) infection, pneumonia, septicemia, viral hepatitis, and wound infection and 30-day prevalence of urinary tract infection (UTI). Admission assessments were excluded. Annual infection counts were estimated using 2013 data. Changes in the prevalence of reported infections over time and differences in trends between MDS 2.0 and 3.0 were examined using tests of linear trends. In 2013, there were an estimated 1.13 to 2.68 million infections in NH residents. UTI and pneumonia were the most commonly reported infections in every quarter, ranging from 5.6% to 8.1% and 1.4% to 2.5%, respectively. Prevalence of all infections increased in 2006–2010 (P values < .01). In 2011–2013, prevalence of UTI, MDRO, and wound infections decreased and viral hepatitis increased (P values < .0001). Between MDS 2.0 and 3.0, the prevalence of UTI, MDRO, and wound infections decreased and the prevalence of viral hepatitis increased (P values < .0001). Infections are a major and persistent problem in NHs. Although MDS data are useful for identifying trends in infection prevalence, revisions in definitions need to be accounted for when evaluating trends over time. Additional research is needed to identify factors that contribute to changes in infection prevalence.

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